In many areas where lots of people receive aid, good, nutritious food can be scarce. The District's Ward 8 went nine years without a full-service grocer. (By Katherine Frey -- The Washington Post)Buy Photo

The worsening economic crunch is causing the tab for food assistance programs to balloon, and with the rising costs has come an intensifying debate over whether -- and how -- the U.S. government can tackle simultaneously the paradoxically linked problems of hunger and obesity.

The statistics spell out the dilemma. The number of Americans on food stamps topped 31.5 million in September, a record high. Obesity, too, is at epidemic levels: In 30 states, at least 25 percent of the population is dangerously overweight. Nationally, 31.9 percent of children are considered overweight or obese.

For decades, the government has treated hunger and obesity as unrelated phenomena. But at a news conference last week in Chicago, Tom Vilsack, President-elect Barack Obama's choice for agriculture secretary, said he would put "nutrition at the center of all food assistance programs," a signal that he will get involved next year when Congress moves to reauthorize nutrition programs that support school breakfasts and lunches as well as summer food for children.

"For a long time, we've looked at hunger and obesity separately," said Sen. Tom Harkin (D-Iowa), chairman of the committee that will draft the legislation. "It's not a zero-sum game."

Public health advocates have long hoped to link food assistance to good nutrition. To the anti-hunger lobby, however, mandating what kind of food needy people should eat is impractical and smacks of paternalism. It would be impossible, they say, to determine which of the 50,000-plus products in the grocery store should be classified as healthful.

Would Diet Coke pass the test? What about the juice drink Sunny Delight? In 2004, the Agriculture Department rejected a request from the Minnesota Department of Human Services to ban the purchase of candy and soft drinks with food stamps.

More important, anti-hunger activists say, low-income people often choose higher-calorie snacks and fast food because such fare is cheaper and more readily available where they live than nutritious fruits and vegetables. The District's Ward 8, for example, had no full-service supermarket for nine years until a Giant Food store opened last December.

"If there are areas in cities where there isn't an apple for sale within a mile radius, restricting food stamps goes beyond paternalism to a form of abuse," said Jim Weill, president of the Food Research and Action Center, a D.C.-based anti-hunger policy organization.

But with hunger and obesity reaching unprecedented levels, some anti-hunger activists are beginning to soften their stance. According to a report by the Partnership for America's Economic Success, toddlers whose families have gone hungry are three to four times as likely to be obese. If the current recession resembles past downturns, the independent Center on Budget and Policy Priorities predicts, the number of Americans in poverty could rise by as many as 10 million, driving up obesity, diabetes and cardiovascular disease.

"It was a very slow and difficult transition for me and my organization," said Kenneth Hecht, executive director of California Food Policy Advocates, a Los Angeles-based anti-hunger organization. "What we wanted to do was get more calories to people. Now we find it isn't more calories. It's more of the right calories."

To that end, the organization lobbied for a bill that would create incentives for recipients of food stamps to purchase healthful food. Gov. Arnold Schwarzenegger (R) signed the bill into law in 2006, but the program never received funding.

The debate in California attracted national attention, however. In the 2008 farm bill, Congress allocated $20 million for a pilot program to explore how to create incentives to purchase fruits, vegetables or other healthful foods in order to improve the diets of food stamp recipients and potentially reduce obesity. Several nonprofit groups and foundations are experimenting with similar incentives.